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*I started writing this nearly three years ago, and it has taken me a while to decide whether to post it. I freely admit that it is not without trepidation I am publishing this. Not only is it somewhat unflattering personally, it will unavoidably reflect poorly on a past employer. In those intervening three years I have hope to have gained perspective and maturity. This is intended as a reflection on the cultural justifications for abuse of power, and how the cultural manifests in the personal. *

Or, the misapplication of power in care-work

In the spring of 2021 I found myself in a meeting at work1, reflecting on how the style of leadership had changed2 the past year. The emphasis had shifted from “the daily routine is all important” to “predictability allows for adjustments in the moment, moment to moment”. Well, all well and good. A minor adjustment to emphasis in the day to day social work sausage, as it were, right?

Well, not quite. This quite ordinary meeting led to me reassessing quite a few of my (many!) years in social work, and how I’ve grown more self-aware.

Working at an assisted living facility entails managing all aspects of the residents’ lives. From ensuring they are adequately clothed and fed, through administering appropriate medication; to facilitating a range of positive and meaningful experiences. The residents where I work have quite profound cognitive challenges; with difficulties in understanding the world around them, the consequences of their actions, and in planning activities and carrying out these plans.

All of this compounds to a rather stark imbalance in the relationship between the caregiver and the cared for. Any and all (immediate3) agency the residents have will be negotiated through the judgment of the caregivers and their assessment of the capabilities of the resident. This assessment will (or should) be based on a collective understanding of the resident, their character traits etc., as well as an unavoidable immediacy I find innate to people work. Thus, there will (or should) be a general agreement among caregivers as to the extent any resident can honor a given demand — which can be as mundane as deciding between oatmeal and cornflakes for breakfast.

Good intentions gone bad

Problems arise when these assessments are needlessly (and illegally, at least in Denmark) pessimistic as to the residents (lack of) capabilities. Thus, with the best of intentions, the agency (such as it is) of the resident is needlessly hampered.

The following two examples from my experience are quite clear:

The resident is playing with toys at night instead of sleeping. The immediate solution: toys are locked away at bedtime

The resident is immediately disruptive if they leave their apartment. The obvious remedy: double-twist doorknobs are installed to prevent egress

Now, readers, bear over with me, for I have sinned. I have gone along with these transgressions. This is not my proudest professional accomplishment. Good intentions can be blinding.

Add to this the prior management encouraging a sense of the goals justifying the means. It is for their own good and in their best interest!

Granted, there are quite a few gray areas to be found when caring for the differently abled; in the intersection of responsibility of care and respect for agency. The challenge and responsibility given to us who work as caregivers is to navigate these gray areas as respectfully as possible.

I have personally failed in this regard, and can only aspire to do better, and call out any other transgressions I see as a carer.

The power entrusted to delegated from management

The expanse and excess of the encroachment of the previous leadership upon the personal agency of the residents is, in fact, too long and tedious to list 4

But they were not constrained to limit the agency of the residents. They hindered the negotiation and navigation necessary by us, the footsoldiers, thus further increasing the chances of abuses of power and undue stress upon the residents.

One of the phrases often repeated during the meeting I mentioned above was:

We trust your judgement as front line responders

This in contrast to the previous administrator. We had assessed a resident as not up for a planned, recurring afternoon walk. The manager questioned this decision, and (implicitly at least) overruled us. The afternoon walk was hastily implemented, and, predictably, the situation escalated later that evening, to great distress5 for the resident as well as the staff.

This was not the only occurrence of institutional and/or administrative norms and decisions overruling the needs and desires of the residents, often over the heads of the staff. To see and hear that the new6 is turning over a new leaf as regards resident agency and well-being as well as staff competency and situational knowledge is quite refreshing.

Navigating grey areas and conflicting imperatives

What I would like for you to take away from this… confession? is that people-work is hard. Management can help shoulder the burden, though. By trusting in the judgment of the workers and the residents — the resident can quite well know a walk is not the most important thing right now; or the worker can and must read the entirety of the immediate now as well as past and future stimuli to modulate the intervention in the present.

And also by establishing guidelines for professional care that allow for a measure of humility in the uneven relationship between carer and resident. Plans must be reassessed when the rubber meets the road. This humility is necessary to navigate the gray areas mentioned above.

Yes, we have an obligation towards those in our charge. An obligation that extends to leaving our preconceived notions at the door. The one who liked to play at night? They got help putting their toys away when ready. The one who was feared to be disruptive in the common areas? Yes, somewhat justified, but mitigated by actually doing our jobs. Mostly he enjoyed a greater independence and better sense of agency.

We hold all the cards as caregivers. We can at least play with the cards face up.

This concludes my thoughts from (mostly) three years ago. I have since changed my workplace. The balancing act of navigating my professional intention with the interests and desires of those in my charge persists, however. I hope to demonstrate a humility and decency through my work, and be an example for others to follow.

  1. As I’ve mentioned before, I work at an assisted living facility for adults with autism and related disorders. 

  2. In no small part due to a rather sudden restructuring of the management. A long and possibly interesting story, that, should anyone wish to dig out the buried skeletons. 

  3. This is a demographic with very little true agency, caught up in a system that is heavily bureaucratised and impersonal. 

  4. …yeah. This sounds bad, and it is bad. Again; there is probably quite the interesting story to uncover here, if anyone ware so inclined. 

  5. The self-harming and outwardly reactive kind of distress. Not… great. 

  6. the new management does retain some members of the old; but with newfound agency (heh) to affect change differently